title: Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a nosocomial infection of multifactorial etiology and has a negative influence on cardiovascular surgery (CVS) outcomes.
  
  
  OBJECTIVE
  Determine the effect of toothbrushing plus 0.12% chlorhexidine gluconate oral rinse in preventing VAP after CVS.
  
  
  METHODS
  In a quasi-experimental study, patients undergoing heart surgery were enrolled in a protocol for controlling dental biofilm by proper oral hygiene (toothbrushing) and oral rinses with 0.12% chlorhexidine gluconate (Group 1), and they were compared with a historical control group (Group 2), which included patients who underwent cardiac surgery between 2009 and 2010 and who received regular oral hygiene care. Seventy-two hours before surgery, a dentist provided instruction and supervised oral hygiene with toothbrushing and chlorhexidine oral rinses to patients in Group 1.
  
  
  RESULTS
  Each group comprised 150 patients. A lower incidence of VAP (2.7% [95% CI 0.7-7.8] vs 8.7% [95% CI 4.9-14.7], P = .04) and a shorter hospital stay (9 ± 3 d [95% CI 8.5-9.5] vs 10 ± 4 d [95% CI 9.4-10.7], P = .01) were observed in Group 1. No significant differences in all-cause in-hospital death were observed between groups (5.3% vs 4.7%, P > .99). The risk for developing pneumonia after surgery was 3-fold higher in Group 2 (3.9, 95% CI 1.1-14.2).
  
  
  CONCLUSIONS
  Oral hygiene and mouth rinses with chlorhexidine under supervision of a dentist proved effective in reducing the incidence of VAP.
authors.affiliation: Department of Clinical and Oral Pathology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Liliana Noemí
authors.initials: LN
authors.lastname: Nicolosi
authors.forename: Maria
authors.initials: M
authors.lastname: del Carmen Rubio
authors.forename: Carlos Daniel
authors.initials: CD
authors.lastname: Martinez
authors.forename: Nidia Noemí
authors.initials: NN
authors.lastname: González
authors.forename: Marisa Edith
authors.initials: ME
authors.lastname: Cruz
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D013504:Cardiovascular Surgical Procedures; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D014099:Toothbrushing
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: cardiovascular surgery; chlorhexidine; prevention; ventilator-associated pneumonia